FROM JAMA PEDIATRICS
Daily full-body moisturizing of babies from birth to 6 months of age was cost effective and may prove to be a simple preventive strategy to reduce the burden of atopic dermatitis (AD), according to a report published online on Dec. 5 in JAMA Pediatrics.
The annual cost of AD in the United States is estimated at $364 million to $3.8 billion. Preliminary studies have suggested that applying moisturizers every day for the first several months of life to babies at high risk of developing AD reduces the cumulative incidence of the disorder by approximately 50%, said Shuai Xu, MD, of the department of dermatology, Northwestern University, Chicago, and his associates.
To assess the cost effectiveness of this preventive strategy, the investigators calculated the body surface area of hypothetical babies from birth to 6 months and obtained the average price of seven common moisturizers available at four online retailers to determine the cost per full-body application. They then calculated the quality-adjusted life-years (QALY) for AD using reported prevalences of mild, moderate, and severe disease, then calculated the cost effectiveness of moisturizing using the previously reported relative risk reduction of 50%. Their mathematical model assumed that all the moisturizers had equivalent efficacy (JAMA Ped. 2016 Dec 5. doi: 10.1001/jamapediatrics.2016.3909).
The average amount of moisturizer needed was 3.6 g/day at birth, increasing to 6.6 g/day at age 6 months. The cost for these amounts ranged from $0.13 per ounce to $2.96 per ounce for the seven moisturizers. Petroleum jelly was the most affordable product, costing just $7.30 for a 6-month supply, and Vaniply ointment was the most expensive, costing $173.39 for a 6-month supply. The costs of Aveeno Eczema Therapy moisturizing cream, Cetaphil moisturizing cream, CeraVe moisturizing cream, Aquaphor Baby Healing ointment, and sunflower-seed oil fell between the costs of these two products.
For preventing AD, petroleum jelly was the most cost-effective product at $353 per QALY and Vaniply ointment was the least cost effective at $8,386 per QALY. All the moisturizers easily met the widely accepted threshold for cost effectiveness of $38,000 per QALY, Dr. Xu and his associates said. “Beyond the direct cost savings in preventing atopic dermatitis, preserving the skin barrier early in life for high-risk individuals may theoretically reduce the risk of developing other atopic diseases. For instance, neonatal skin barrier dysfunction is associated with food allergies at 2 years of age,” they noted.
“Furthermore, prophylactic moisturization may mitigate the risk of the occurrence of a growing list of atopic dermatitis comorbidities, which include sleep disturbances, obesity, anemia, and attention-deficit/hyperactivity disorder.”
This study was limited in that it did not include any human participants and did not measure the actual development of AD throughout childhood, but instead relied on mathematical estimates and predictions. “Larger-scale studies with longer follow-up will determine whether prophylactic moisturization simply delays the onset of atopic dermatitis or alters the actual disease course,” Dr. Xu and his associates wrote.
No sponsor was cited for this study. Dr. Xu reported being the founder and an equity owner of a website providing safe product recommendations for patients with AD, which has no financial relationships with makers of any skin products. He also reported receiving a one-time travel award from Aquaphor manufacturer Beiersdorf to present research at a medical conference. One of his coauthors reported being a consultant and/or advisor for Anacor/Pfizer, Exeltis, Galderma, Johnson & Johnson, Pierre Fabre, Regeneron, Sanofi, Theraplex, and Valeant.